从络病学角度探讨脑络瘀塞证的病性辨证与脑侧枝级联的关系*
作者：姜海伟，高 畅，王 丹，严 丹
单位：江汉大学附属湖北省第三人民医院，湖北 武汉 400033
引用：引用：姜海伟，高畅，王丹，严丹.从络病学角度探讨脑络瘀塞证的病性辨证与脑侧枝级联的关系[J].中医药导报,2025,31(3):101-105.
DOI：10.13862/j.cn43-1446/r.2025.03.017
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摘要：
目的：从络病学角度探讨“脑脉瘀塞”证的病性辨证与脑侧枝级联（CCC）的关系。方法：116例缺血性脑卒中患者根据络病学辨证为“脑脉瘀塞”证，对其病性辨证，包含主证（络气虚滞及络气郁滞）及兼夹证（血瘀、痰浊、郁热、痰热、阴虚、阳虚）。通过计算机断层扫描脑血管成像（CTA）评估其CCC，对脑动脉软膜支代偿、组织水平侧支和静脉回流进行综合评价，分级为良好侧枝级联（CCC+）、不良侧枝级联（CCC-）及混合型侧枝级联（CCCmixed）。评价其不同的病性与CCC的对应情况，采用相关性分析分析其病性与CCC的关系。结果：116例患者中CCC+者为42例（36.21%），CCC-为40例（34.48%），CCCmixed为34例（29.31%）。通过单因素及多因素多变量分析发现，CCC+与络气虚滞证及兼夹瘀血、阳虚的存在呈正相关，而CCC+与络气瘀滞证及兼夹痰浊、郁热、痰热的存在呈负相关。结论：“脑络瘀塞证”不同的病性与不同的侧枝级联水平具有一定的相关性，为缺血性卒中急性期的通络治疗及预后判断提供了一定依据。
关键词：脉络-血管系统疾病；缺血性脑血管病；脑络瘀塞证；病性辨证；脑侧枝级联；络病学；相关性分析
Abstract：Objective: From the perspective of collateral disease,
to explore the relationship between pathological differentiation of
"cerebral arteries stasis syndrome" and cerebral collateral cascade
(CCC). Methods: A total of 116 patients with ischemic stroke were diagnosed
with cerebral arteries stasis syndrome based on collateral disease theory.
Syndrome differentiation included primary syndromes (deficiency and stagnation of collateral qi)
and secondary syndromes (blood stasis, phlegm turbidity, depressive heat,
phlegm heat, yin deficiency, and yang deficiency). CCC were evaluated using
computed tomography angiography (CTA), comprehensively assessing pial artery
compensation, tissue-level collaterals, and venous return. CCC was classified
as good collateral cascade (CCC+), poor collateral cascade (CCC-), and mixed
collateral cascade (CCCmixed). The correspondence between different syndromes
and CCC was evaluated, and the relationship between syndromes and CCC was
analyzed using correlation analysis. Results: Among the 116 patients, 42
(36.21%) were classified as CCC+, 40 (34.48%) as CCC-, and 34 (29.31%) as CCCmixed.
Univariate and multivariate analyses revealed that CCC+ was positively
correlated with deficiency and stagnation of collateral qi, and the presence of
blood stasis and yang deficiency, while CCC+ was negatively correlated with
stagnation of collateral qi, and the presence of phlegm turbidity, depressive
heat, and phlegm heat. Conclusion: Different pathological differentiation of
"cerebral arteries stasis syndrome" is related to the different grade
of collateral cascade, which provides the evidence of syndrome differentiation
for the treatment of acute ischemic stroke and the judgement of prognosis.
Key words：collateral-vascular system disease; ischemic cerebrovascular disease; cerebral arteries stasis syndrome; syndrome differentiation; cerebral collateral cascade; collateral disease theory; correlation analysis
发布时间：2025-12-15
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